To Medical Student Activists on the Anniversary of the White Coat Die-In

One year ago, on December 10, 2014, over 3,000 medical students participated in the National White Coat Die-In. We knelt to the ground, rested our backs on concrete and tile, looked up at the ceiling and contemplated what it meant to be a citizen. We embraced a deafening silence pregnant with the implications of erasure. Our bodies, cloaked in the privilege of a white coat, painted a complicated image of advocacy and appropriation.

We asked people to consider: what bodies are recognized as fully human?

We hoped to convey a denial of complicity with a system that had allowed for the non-indictments of individuals responsible for the needless death of black people. We wanted to demonstrate solidarity with the broader mission to identify systemic racism as a national public health issue.

For one, my coat is no longer a clean, monotonous bone white. It is scarred with stains and creases — badges acquired more likely as a result of carelessness, stray pens and fabrics that leave kisses of errant dyes than any sensational clinical encounter. Nonetheless, each won by experience.

Other things have changed. It feels like there is higher energy — that there are more organizations and coalitions fighting this fight, more student-doctors with a commitment to social justice at the center of their professional and personal mission. There are louder voices, more panels and discussions, increased letters to the administration and letters to the editor. There are new sessions on bias, more conversation of structures, additional attention towards inequality and injustice.

But some things have not changed. The conversations are still hard and uncomfortable. Change is still slow. Efforts are easily dismissed. There is still anger, hurt, trauma and pain.

The change closest to home: I am burned out. This work feels heavier than it did a year ago — it takes more energy from me than it did last year, gives me less energy than it did last year. I am so tired of watching beautiful, vibrant people feel downtrodden and uncared for in spaces that promised them so much more.

More frequently, I wish I did not care.

More frequently, I think, “I do not want to do this anymore.”

I find myself much less patient towards people who “don’t get it.” I am less likely to engage, less willing to meet people where they are. I am struggling with a deep and ugly shame — a growing resentment toward people who are able to walk away from continued engagement with inequality. I am troubled that my efforts and work towards fighting for goodness have, in some ways, birthed this odious echo of superiority. I am ashamed of feeling exhausted when my body is safe and secure in a position of remarkable privilege. I am forever not enough.

It does not feel good.

I am caught between a challenge to practice more amity, more love and more patience, all the while reminding myself, and others, that there a very serious importance to self-care, to learning how to say no. There is also something to be said about laboring to teach people when they have the resources and ability to find answers themselves.

In the midst of fatigue and a flurry of organizing, manuscripts, op-eds, deadlines, and attempts to seek people in higher positions of power, I have to remind myself that the endeavor to fight inequality has to be predicated on a love — a more radical sort of love — that denies achievement as a primary driver. As Alok Vaid-Menon says in one of my favorite TEDTalks, “Success, is about self promotion, not putting change into motion.” It is a healthy reminder to deny the pressures that frame triumph within personal accomplishment. This work, at a more basic core, needs to attempt to strip away notions of individualism and be more fully couched in community.

Medical school asks us to prove ourselves in ways that can be identified on a resume linked only to one name. We are in a pre-professional school. We are not in a radical space. Working within these walls has, in some ways, challenged our idealism with reality, practicality and strategy. I often feel the disappointment that comes with asking for what we think may be achievable, as opposed to demanding what we need. We are taken further away from community spaces, pushed closer to board rooms and conference centers. The projects we rally around are those that are publishable and recognized rather than those that have a better chance of building the collaborative, sustainable, long-term movements that combat transience. I wonder if we were duped, perhaps even by ourselves. I wonder if, instead of pursuing publications and presentations, we would make much more progress simply by making more time to meet strangers, break bread, shake hands, slow down.

I am weary of the complicated line between fighting to end inequality in our local communities, and fighting for our own professional development. What does it mean to commodify progress? To perform activism and attach it tightly to ownership?

I think we have to begin to conceptualize reward, reason and incentive in different ways. I have become, and have to be, more conscious of how destructive the notion of individual achievement can be to meaningful progress — how our society’s emphasis on personal recognition and merit holds back opportunities to grow anti-oppression efforts. This work is about showing up and standing up for the people you share your space with. This work is a call for community building, a call to have love for other people at the center, forefront and foundation of its efforts. A love that is able to fight against a system that measures success along individual achievement, profit, and recognition. A love that — slowly, painfully, and despite how valuable they are in working towards our own dreams and aspirations — tries not to climb to a higher rung of a slanted social ladder, but to bring the entire system closer to the ground (or indeed, construct a whole new system all together).

This work is about fighting to attain power, only to give it away.

I understand this is hard. It hurts to give away power when it took so much effort to mine. Activism is not a lucrative tradition — I know many sacrifices have already been made. It is difficult, and I am hesitant, to ask people in this activist community to be more selfless — to practice the politics of rejecting ownership of and giving away their hard won returns. I do not expect it to be easy. I expect myself to falter many times. I wonder if this essay itself only reifies the problem stated.

This reflection is imperfect. I wish I had more time to make it beautiful. I wish I were not spontaneously writing this at five in the morning. I wish I had more time to roll the words across my mind, edit, rephrase, reconsider — there is a lot I am trying to convey that is hard to articulate on paper, that can be easily misconstrued, that is complicated and nuanced in a way I am struggling to fully express in these paragraphs. I wish I knew more clearly what I was trying to say, was able to provide solutions instead of serving a jumble of internal demons and dilemmas.

As time passes and things change, it has been ever more important to remind myself why I am here, why I do this.

Here is what hasn’t changed: The people in my communities are amazing, brilliant, energetic and validating. I have been lucky enough to be connected with people across the nation who are working tirelessly for better resources for their peers, for more knowledge to combat an intellectual ignorance that resides in medical curricula, for programs and attention and recognition of the needs of their local communities, for their schools, for this profession, and for their patients.

Here is what hasn’t changed: When everything feels futile, I feel worthless, and this work feels aimless, and I wonder if I was wrong this whole time, being connected with the people in my community seems like enough.

So I end with a challenge to hold myself more accountable to the idea that this labor must be predicated on love, to remember that sometimes, failure as we know it can be the greatest triumph. I end by sending energy and warmth and gratitude to the people who have struggled tirelessly and often thanklessly to better their communities. I am indebted to the people around me who have served as teachers, allies, and friends; who keep me humble merely by demonstrating to me so clearly what grace, strength and passion are.

In no particular order: To the working groups I am a part of, to my friends, to Alpert Medical School and Brown University, to my family, to Providence — to my communities — I am going to continue to fight for, with, and by you.

The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.

I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!

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in-Training is the agora of the medical student community, the intellectual center for news, commentary, and the free expression of the medical student voice. We publish articles about humanism in medicine, patient stories, medical education, the medical school experience, health policy, medical ethics, art and literature in medicine, and much more.